AB1558 CLINICAL-ECOGRAPHIC OPTIMIZATION IN RHEUMATOID ARTHRITIS IN SUSTAINED REMISSION
Authors: G. Añez, V. Torrente Segarra, M. Bonet, M. Castillo Vilella, L. Orpinell, A. Ponce Fernandez, N. Busquets-Pérez, M. Pascual-Pastor, H. Corominas, C. Diaz-Torne, P. Moya, J. J. De Agustin
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In recent years, the high economic impact of biologic therapies (BT) on health care systems has promoted great interest in optimizing BT in Rheumatoid Arthritis (RA) patients in sustained clinical remission (CR). A relevant percentage of those optimized patients present clinical relapses. RA patients in CR have been shown to have active synovitis detectable by ultrasound (U). U can identify synovitis in patients about to present clinical relapse. U can be a useful tool in the optimization decision. <h3>Objectives</h3> The main objective was to demonstrate that the optimization strategy using U is more useful than the strategy using clinical index. U used as an outcome measure, can further refine the choice of patients who are candidates for a reduction in treatment and therefore achieve lower relapse rates. To do this, we calculated the relapse rates in each of the groups and the time from the beginning in which it appears, and we compared them to assess whether they differ significantly and support our hypothesis. Secondary objective was evaluating the ultrasound remission in this group of patients. <h3>Methods</h3> We conducted a multicenter, randomize, prospective study in 5 tertiary centers in RA patients in sustained CR (&gt;9 months). All signed the informed consent. Approval by the ethical committee was obtained (VDH-INF-2017-01). Two blinded and randomize arms, clinical (A) and U (B) were created to decide tapering (1/2, 1/3 or no reduction treatment) and compare flare rates (&gt;1.2 DAS28 or &gt;16 SDAI/CDAI increase) in 52 weeks (basal, 1, 6, 9 &amp; 12 months). Demographic at baseline, US &amp; clinic variables, and ESR &amp; CRP at each visit, were registered. By using U with grayscale (GS) and power Doppler (PD) in a semiquantitative articular (A) and tendon (T) scale we studied: wrist, 1-5 MCP, 1-5 PIP, ankle, subtalar joint, 2nd, and 5th MTP, extensor tendons (Text) and flexors (Tflex) of the carpus, flexor tendons of the fingers, posterior tibial and peroneal tendons. DAS28 &lt;2.6 was used as the clinical remission criteria, and the absence of synovitis was defined as U remission (EG and PD = 0). U activity was defined as GS≥1 and PD ≥1. <h3>Results</h3> 78 patients were included, 48 completed 12 moths follow up and 28 were retired (5 screening failure, 16 flare, 5 lost follow up &amp; 4 patient decision). 33 men and 45 women, 11.92 years of disease. Group A presented a significative more flare rates than group B (10 vs 6). Using SDAI or CDAI only 7 presented a clinical flare, and for SDAI (7 vs 0) &amp; CDAI (7 vs 0) differences were significative (p&lt;0.005), but not for DAS28 (10 vs 6) (Table 1). In U at baseline, the main involved joint was the wrist (28.6%), and of the tendons the Text (11.2%). In 53% a pathological U (A and T) was observed, 46.9% had pathological A and in 30% pathological T was observed. Considering as remission an ultrasound score of EG + PD = 0, only 46.9% were in remission. <h3>Conclusion</h3> Ultrasound can improve tapering strategy when we used SDAI or CDAI score in patients in sustained clinical remission. Clinical and ultrasound remission are not equivalent. More than half of the patients do not fulfill UR and in one fifth of them a strict control should be carried out to avoid a relapse of the disease if it is decided to optimize. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.